LCD and Policy Article Revisions Summary for October 26, 2017

Outlined below are the principal changes to the DME MAC Mechanical In-exsufflation Devices and Nebulizers Local Coverage Determinations (LCD) and Policy (PA) that have been revised and posted. Please review the entire LCDs and related PAs for complete information.

Mechanical In-exsufflation Devices
LCD
Revision Effective Date: 10/01/2017

ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: New ICD-10 codes
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Clarified: Verbiage in Policy Specific Documentation Requirements

10/26/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

Nebulizers
LCD
Revision Effective Date: 10/01/2017

COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Update: References to ICD-10 Codes that Support Medical Necessity
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: New ICD-10 codes to Groups 11, 12, 13
Deleted: Non-valid ICD-10 codes from Group 11, 12, 13
Revised: ICD-10 code descriptions in Groups 2, 3, 7, 12, 13

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Update: Language to add "justify", for Medicare reimbursement

10/26/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

PA
Revision Effective Date: 01/01/2017

NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PERSUANT TO 42 CFR 410.38(g), previously in the Policy Specific Documentation Requirements section

Note: The information contained in this article is only a summary of revisions to the LCDs and PAs.  For complete information on any topic, you must review the LCDs and/or PAs.

Last Updated Wed, 25 Oct 2017 11:26:54 +0000